Primary angioplasty in acute myocardial infarction: does age or race matter?

Recent data suggest substantial variations in the treatment of acute myocardial infarction based on age, race, gender and socioeconomic status. We evaluated the use of primary angioplasty (PA) in acute myocardial infarction (AMI) in elderly and minority patients treated at an urban, teaching hospital.

We reviewed the records of 322 patients with AMI admitted to an urban, teaching hospital from 1997-2000. Our main outcome was PA in AMI. Secondary outcomes included use of post-infarction therapies. Univariate analysis was performed on the variables of interest, age and race, as well as all candidate variables.

Unadjusted analysis revealed that elderly and African-American patients were significantly less likely to receive PA for AMI, and post-infarction beta-blockers, (all p <.05). Other factors that had a significant negative impact on use of PA included do-not-resuscitate status, increasing acuity of presenting signs and symptoms, severity of illness, dementia and subendocardial infarcts (all p <.05). After adjustment for these potential confounders, increasing age remained inversely associated with both PA (p <.001), and use of standard post-myocardial infarction beta-blockers, (p <.05). Additionally, African-American patients in our study were less likely to undergo PA as initial AMI (p <.01).

Our results indicate differences in the use of PA in the elderly and African-Americans. These differences are not explained by severity of illness and suggest that interventions and standard therapies may be withheld from those who may benefit most.